Vestibular schwannoma microsurgery peculiarities for better functional outcome and result comparison

Vestibular schwannomas (VS) are surgically challenging due to proximity to critical neurovascular structures. Preservation of facial and cochlear nerve function is essential for quality of life (QoL). Does a refined microsurgical technique with extent of tumor resection improve functional outcomes, quality of life, compared to conventional surgery? The need for generally accepted scale of VS removal radicality. ? This retrospective cohort study included 829 patients treated at the Subtentorial Neurooncology Department Romodanov Institute of Neurosurgery (2001–2024). Group 1 (n=474) underwent conventional surgery; Group 2 (n=355) received a modified strategy with preoperative CT-MRI planning, intraoperative neuromonitoring, and nerve-sparing dissection. Facial nerve function was assessed using the HB, and QoL with PANQOL in 118 patients with paired data. Authors Vestibular Schwannoma Resection Grading scale (VSRG) suggested. Group 2 showed significant PANQOL improvements: Pain (+19.5%), Facial Function (+35.6%), General Health (+15.7%), Total Score (+11.1%), with smaller gains in Hearing (+8%), Balance (+4%), and Energy (+2.3%). Cochlear nerve preservation was achieved in 52.7% of patients with functional hearing in Group 2 versus none in Group 1. Total and subtotal resections were more frequent in Group 2 per VSRG, correlating with lower early residual tumor regrowth (mean follow-up 49.5 vs. 159.4 months) and higher QoL. Individualized planning, nerve monitoring, and nerve-sparing dissection improves early functional outcomes, QoL, and extent of tumor resection. Prospective studies are needed to confirm long-term tumor control. • Novel microsurgical technique enhances facial and cochlear nerve outcomes • PANQOL reveals notable quality-of-life improvements after refined surgery • VSRG grading system suggested standardizes tumor resection assessment • Preoperative CT-MRI planning enables tailored surgical strategies • Updated microsurgical approach improves quality-of-life scores